Teaching the rectal examination with simulations: effects on knowledge acquisition and inhibition.

Context: Undergraduate medical curricula are often deficient in teaching physical examinations in intimate zones, such as the rectal examination. Student inhibition is assumed to substantially hamper both the acquisition of knowledge and the performance of these examinations in practice.

Objectives: The two present studies examined the effects of low-fidelity (LFS) and high-fidelity (HFS) simulation on the acquisition of the necessary knowledge and inhibition about carrying out the rectal examination. In addition, we investigated the effects of the different sequencing of the two simulations (HFS-LFS versus LFS-HFS).

Methods: A manikin for the rectal examination was used to implement the LFS. Standardised patients (SPs) were used to implement the HFS. Study samples consisted of 41 (Study 1) and 188 (Study 2) female and male undergraduate medical students. Each student participated in two individual sessions of 30 minutes each. Half the students participated first in the HFS and then in the LFS and the other half participated in the simulations in the opposite order. Outcome measures were self-rated inhibition and knowledge tests.

Results: In both studies, HFS was found to reduce inhibition significantly more than LFS. Furthermore, in Study 2, a marginal effect of the sequence of simulation was found. In both studies, both types of simulation were found to facilitate the acquisition of knowledge. There was no sequence effect for the acquisition of knowledge.

Conclusions: Teaching the rectal examination with the help of SPs, who represent an HFS, can help medical undergraduate students to overcome inhibition about this examination. Standardised patient simulation is far more effective than that achieved using a manikin, which represents an LFS. Both types of simulation support the acquisition of knowledge.